Cannabis Legalization Linked to Cannabis Poisoning in Older People

Cannabis legalization may be associated with an increased risk of emergency department (ED) visits for cannabis poisoning in older people, a study in JAMA Internal Medicine has found.

Nathan M. Stall, M.D., Ph.D., of the Sinai Health and the University Health Network in Toronto and colleagues analyzed data from the Ontario Ministry of Health to examine ED visit rates for cannabis poisoning in adults aged 65 and older during three policy periods: prelegalization (January 2015 to September 2018); legalization period 1, which allowed the sale of dried cannabis flowers only (October 2018 to December 2019); and legalization period 2, which also allowed the sale of edible cannabis (January 2020 to December 2022).

Overall, there were 2,322 ED visits for cannabis poisoning in older adults (mean age 69.5 years) during the study period. After adjusting for age, sex, rurality, neighborhood, income, alcohol intoxication, cancer diagnosis, and dementia diagnosis, the researchers found that the rate of ED visits linked to cannabis poisoning among older people doubled in period 1 and tripled in period 2 compared with the prelegalization period.

The researchers offered several possible reasons for the increase following the legalization of edibles; these include a greater likelihood of accidental ingestion, easier access to cannabis products, and lack of age-specific dosing instructions. The researchers acknowledged, however, that they could not determine whether the continued increase was directly related to edible cannabis or a result of broader commercialization of nonmedical cannabis.

Stall and colleagues added that older people are at particularly high risk of adverse effects from cannabis because of age-related physiological changes, potential interactions with other medications, and multimorbidity.

“Overall, this study shows the health outcomes of cannabis legalization and commercialization for older adults and highlights the consequences associated with edible cannabis,” Stall and colleagues wrote. They said that jurisdictions with legalized cannabis should consider measures to mitigate unintentional exposure in older adults and provide age-specific dosing guidance.

For related information, see the Psychiatric Services article “Effects of Recreational Cannabis Legalization on Mental Health: Scoping Review.”

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Youth Suicide Rates Higher in Areas With Greater Poverty, Study Finds

Youth suicide rates are higher in U.S. counties with elevated poverty rates, according to a study published today in JAMA Pediatrics. The association between suicide and county-level poverty was particularly prominent for suicides by firearms.

“As pediatric suicide rates in the United States continue to increase, understanding of the upstream contributors to pediatric suicide, including poverty-related factors, appears to be needed so that suicide prevention efforts can focus on the youths at highest risk,” wrote Jennifer Hoffmann, M.D., of the Ann & Robert H. Lurie Children’s Hospital of Chicago and colleagues.

For the study, the researchers analyzed 2007-2016 death certificate data for youth (aged five to 19) collected by the Centers for Disease Control and Prevention along with income data from the National Census Bureau. They found youth suicide rates were higher in counties with greater poverty. For example, compared with counties in which less than 5% of the population lived below the federal poverty level ($21,027 in annual household income for a family of four in 2007 and $24,339 in 2016), counties with poverty rates of 20% or more had 1.37 times as many suicides by youth each year.

The researchers then analyzed the three most common methods of suicide during the study period (firearms, poisoning, and suffocation). They found no association between the rate of suicide by suffocation or poisoning and poverty levels. Among firearm suicides, the suicide rate increased with increasing levels of poverty compared with the lowest levels of poverty.

“The independent association between county poverty concentration and pediatric suicide … should prompt research into potential mediators through which poverty might convey an elevated suicide risk,” Hoffman and colleagues wrote. “On a more societal level, strategies that combat poverty, such as increasing the minimum wage, may be part of a multipronged strategy to consider for reducing youth suicide.”

To read more on this topic, see the Psychiatric News article “Rise in Youth Suicide Rates Confounds Experts.”

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Young People With Psychotic Disorder at Highest Risk of Death in Year Following Diagnosis

Young patients newly diagnosed with a psychotic disorder are at higher risk for mortality, mostly due to injuries and poisoning, particularly for the first year or two after diagnosis, according to a study published Wednesday in JAMA Psychiatry.

In fact, the adolescents and young adults studied were more than eight times more likely to die within the first year of being treated for an initial psychotic disorder diagnosis than were patients who received other outpatient services, according to the report by Gregory E. Simon, M.D., M.P.H., of Kaiser Permanente Washington Health Research Institute and colleagues. After initial diagnosis of unipolar depression, patients were three times more likely to die than general outpatients.

For this cohort study, researchers examined eight years of records from several health systems that serve more than 8 million members. They examined records for 11,713 patients aged 16 through 30 who were first diagnosed with a psychotic disorder along with two comparison groups: 35,576 patients who received outpatient services and 23,415 patients with a first diagnosis of unipolar depression.

The researchers found that for every 10,000 patients, 55 of those with a first diagnosis of psychotic disorder died within the first 12 months, compared with 21 deaths of those with first diagnosis of unipolar depression and 7 of those seen by general outpatient services. Of the 64 patients who died within a year of a psychotic disorder diagnosis, more than half were from injuries or poisoning (34% self-inflicted, 17% unintentional). For patients with an initial diagnosis of unipolar depression, more than half of the 48 deaths (54%) were self-inflicted.

Overall mortality and mortality due to injuries and poisonings decreased gradually during the three years after initial diagnosis with psychosis. However, such mortality remained elevated in comparison with patients who received general outpatient health services and those who were newly diagnosed with unipolar depression.

“Our findings support the importance of systematic early intervention for young people experiencing the first onset of psychosis. Strong evidence supports the effectiveness of coordinated specialty care programs for improving clinical outcomes,” the researchers noted. They added that few such patients receive this type of care. Some studies have suggested that continuous treatment with antipsychotic medication may also reduce mortality in this group.

For related information, see the AJP in Advance article “Care Pathways Before First Diagnosis of a Psychotic Disorder in Adolescents and Young Adults” and the Psychiatric News article “Gralnick Award Lecturer Emphasizes Importance of First-Episode Treatment.”

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